May 5, 2021 | Volume 12 | Issue 18
Health outcomes in young children following pertussis vaccination during pregnancy
“Maternal immunization with tetanus, diphtheria and acellular pertussis vaccine (Tdap) is routinely recommended in many countries as a strategy to protect young infants against severe pertussis infection.”

A population-based cohort study of 12,045 live births exposed to Tdap in-utero (or not) followed (for up 6 months of age) infant outcomes.

“Exposure to Tdap vaccination in pregnancy is not associated with any increased risk of adverse health outcomes in early childhood.”


See related video HERE & below:
Should You Be Getting Vaccinations While Pregnant?
Association of oral corticosteroids bursts with severe adverse events in childhood
“Oral corticosteroids are the bedrock of treatment for several inflammatory diseases… as recommended by international guidelines.” It has long been known that long-term use of steroids is associated with a number of adverse consequences including Cushingoid features, gastrointestinal (GI) bleeding, infections, glaucoma, hyperglycemia, cardiovascular disease and osteoporosis. There is limited data available on the potential adverse effects of corticosteroid bursts (a drug course lasting <14 days) which is usually considered harmless.

A nation-wide, population-based cohort study of 1,064,587 children (<18 years of age) (using a self-controlled series design) who received a single corticosteroid burst examined 4 potential harms (GI bleeding, sepsis, pneumonia and glaucoma) within 5-90 days following treatment.

A corticosteroid treatment burst in children is association with 1.4-2.2 fold increased risk of GI bleeding, sepsis and pneumonia, particularly during days 1-30 following exposure.


See related video HERE and below:
Association Between Oral Corticosteroid Bursts and Severe Adverse Events
Association of epidural labor analgesia (ELA) with offspring risk of Autism Spectrum Disorder (ASD)
No association between ELA exposure and an increased risk of ASD is found (after adjusting for maternal, sociodemographic, pre-pregnancy, pregnancy and perinatal covariates) from a cohort study of 47011 singleton, live infant offspring who were exposed to ELA (vs. unexposed babies during delivery).
Preliminary findings of mRNA COVID-19 vaccine safety in pregnant
women
From multiple post vaccination health checker surveillance systems which evaluated the initial safety of administering a mRNA vaccine to 35,691 pregnant females 16-54 years of age it appears that injection site pain is more frequent in pregnant than non-pregnant women, while headache, myalgia, chills and fever are reported less frequently. Of 827 women who completed pregnancy 86.1% resulted in a live birth. Adverse neonatal outcomes included preterm birth (9.4%), small-for-gestational age (3.2%) with no neonatal deaths reported.

It appears from preliminary findings (December 2020 – February 2021) that a mRNA vaccination in pregnant women does not result in an increased incidence of adverse pregnancies or neonatal outcomes. (There is a consistent association between pregnant women with a COVID-19 diagnosis and higher rates of maternal mortality, preeclampsia and preterm birth).



See related video HERE & HERE.
Maternal transfer of Cetirizine (ZYRTEC®) into human milk
“Cetirizine is the active metabolite of hydroxyzine, a second generation H1 histamine antagonist,” and is frequently utilized for a number of allergic conditions e.g. allergic rhinitis (which affects approximately 10-20% of the population). It is water soluble (does not cross the blood brain barrier) and is primarily excreted by the kidneys. At present the manufacturer does not recommend use of cetirizine during breastfeeding.

From an observational study of human milk from lactating women taken at 0, 1, 2, 4, 6, 8, 12, and 24 hours after the administration of 10mg cetirizine by mouth, it appears that following usual breast feeding practices that cetirizine is minimally transferred into human milk and is unlikely to pose a significant risk to the breast feeding infant.
Trajectories of opioid use following first opioid prescription in opioid-naïve youth and young adults
“Opioid use disorders continue at epidemic proportion in the US,” with the young being especially susceptible to the adverse consequences (because of biological, social and psychological development) in addition to being at increased risk for opioid dependence, following legitimate medical purposes.

A cohort study of 189,477 opioid-naïve youth (10-21 years of age) examined the patterns of opioid prescribing in the year following a first opioid prescription.

It appears that 25.1% of youth receive more than a single prescription (37.7% from dental practitioners) in the year following an initial opioid prescription. 2 distinct groups appear: a “high risk group” of youth (3.1%) and a “low risk group” (96.9%). 65.3% of “high risk” youth persisted filling opioid prescriptions at 12 months (vs. 13.% of the “low risk” group) with 30% receiving a diagnosis of opioid use disorder (vs. 10.1% of the “low risk” group).

Recurrent, larger dose opioid prescriptions from dentists/general medicine clinicians (47.5%) are frequently associated with a small group of older, non-Latinx white youth, often with a prior diagnosis of mental health problems or with a diagnosis of cancer who are at greatest risk for having opioid dependence within a year following an initial opioid prescription.



See related video HERE & HERE.
Protenus
“Ethics and Compliance” at NCHS in partnership with IT is pleased and excited to announce the launch of a new patient monitoring platform (Protenus) to be implemented in the next few months which will utilize artificial intelligence and machine learning to protect and maintain the integrity of all IT systems at NCHS, secure health care data, examine how EHR is being used, investigate access, identify threats, treatments and payments to NCHS and its patients, ensure that all users are only using EHR for legitimate business purposes, and to review audits, reports, security incidents, privacy violations, stop hacking activity and monitor medical records (differentiating normal clinical care from anomalous behavior) while flagging employee theft of narcotics, contact tracing and more.

For questions or concerns contact the Ethics and Compliance department @ 786.624.3838 or via email.
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COVID-19 - Current Situation in Florida
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Florida's COVID-19 Data and Surveillance Dashboard
Florida Department of Health, Division of Disease Control and Health Protection
Dear Reader:

Though there may be many among you who have undergone immunization against COVID-19, this pandemic may by no means be over. We should be cautious as new mutant strains have arisen which make certainty about the absolute protection afforded by vaccination unclear, their response to treatment uncertain and there is the possibility that the variant viruses may spread even from those who are immunized.

Please continue to take care, wear a mask whenever in public, wash hands well and often, use sanitizer if available, cough or sneeze into elbow and socially distance yourself (preferably at least 6 feet from any person), outdoors, or in a well ventilated area whenever and where ever possible.
 
Best of luck.

Jack Wolfsdorf, MD, Editor
Staff NCH
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